title: Shared decision making in prostate-specific antigen testing: the effect of a mailed patient flyer prior to an annual exam.
abstract: OBJECTIVE
  Professional societies recommend that the decision to screen for prostate cancer involves a shared discussion between patient and provider. Many men are tested without this discussion. Prostate cancer screening decision aids increase patient knowledge and participation in prostate-specific antigen (PSA) testing decisions under ideal circumstances but are often resource intensive and elaborate. There is a need for evaluation of interventions that are low cost, low literacy, and practical for widespread distribution. The authors evaluated the effect of a mailed low-literacy informational patient flyer about the PSA test on measures of shared decision making.
  
  
  METHODS
  A pragmatic randomized controlled trial comparing the mailed flyer versus usual care was conducted among 303 men aged 50 to 74 years who were scheduled for annual health maintenance exams in 2 general internal medicine clinics (University of Colorado and University of Colorado Hospital). Charts were reviewed after the visits for documentation of PSA screening discussions and PSA testing rates. Follow-up patient surveys assessed include perceived participation in PSA screening decisions, knowledge of the PSA test, and flyer acceptability.
  
  
  RESULTS
  Rates of chart-documented PSA discussions were low with no difference between the flyer and control groups (17.7% and 13.6%, respectively; P = .28). Rates of PSA testing were also similar in both groups (62.5% vs 58.5%; P = .48). Rates of patient-reported PSA discussions were higher than the documented rates but also without differences between the groups (71.8% vs 62.3%; P = .22). The intervention had no effect in the PSA knowledge scores (3.5/5 vs 3.3/5, P = .60). Patients found the flyer to be highly acceptable.
  
  
  CONCLUSIONS
  A mailed low-literacy informational flyer was well received by patients but had no effect on rates of PSA discussions, PSA testing, or patient knowledge of prostate cancer screening.
authors.affiliation: Department of General Internal Medicine, University of Colorado, Denver, CO, USA.
authors.forename: Alison R
authors.initials: AR
authors.lastname: Landrey
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Matlock
authors.forename: Laura
authors.initials: L
authors.lastname: Andrews
authors.forename: Michael
authors.initials: M
authors.lastname: Bronsert
authors.forename: Tom
authors.initials: T
authors.lastname: Denberg
mesh_terms: D000368:Aged; D001071:Appointments and Schedules; D003142:Communication; D003657:Decision Making; D055088:Early Detection of Cancer; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010358:Patient Participation; D017060:Patient Satisfaction; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000517:prevention & control
chemical_list: D017430:Prostate-Specific Antigen
keywords: health literacy; pragmatic trial; prostate cancer screening; shared decision making